Effect of combination antiretroviral treatment on total protein and calculated globulin levels among HIV-infected patients

OBJECTIVES: Hypergammaglobulinemia is one of the manifestations of B-cell dysfunction associated with untreated HIV infection. Globulin levels are not routinely measured in HIV-infected patients on treatment. The purpose of this study was to evaluate the effect of highly active antiretroviral therapy (HAART) on calculated globulin levels. METHODS: The study group consisted of 75 HIV-infected treatment-naïve patients, starting HAART, and virologically suppressed for ≥6 months; 16 patients (21%) were HIV-HCV-co-infected. RESULTS: All patients experienced significant increases in CD4 cell counts at 6 and 12 months after HAART initiation compared to baseline (p<0.01 for all comparisons). The increase in CD4 cell counts was significant regardless of the HCV infection status. Significant increases in albumin levels (p<0.05 at 6 and 12 months), reductions in total protein (p<0.01 at 1 year; not significant at 6 months), and concomitant significant reductions in the calculated globulin levels (p<0.001 at 6 and 12 months) after HAART initiation compared to baseline were observed for the whole group. However, less than half the patients achieved a normal albumin/globulin ratio at 1 year. HIV-monoinfected patients had significant changes in albumin, total protein, and calculated globulin levels. In contrast, HIV-HCV-co-infected patients only showed significant increases in albumin levels. CONCLUSIONS: Future studies to evaluate the potential use of calculated globulin levels and albumin/globulin ratios as readily available surrogate markers of B-cell immune reconstitution in HIV-monoinfected patients are warranted.